Dysmenorrhea

What is dysmenorrhea?

• Dysmenorrhea is a condition where there is pain in your uterus (womb) during menstruation. Menstruation is the monthly shedding of tissues and blood from your uterus when you are not pregnant. The pain may be felt as cramping, dull, or sharp. It is felt in your lower abdomen (stomach), and may spread to your lower back and thighs. Dysmenorrhea is also called menstrual cramps, period pain, or painful menses.
  
  
• Dysmenorrhea may be primary or secondary. It is called primary when it occurs without another medical condition. This usually begins 6 to 12 months after your menarche (first menstruation). If your dysmenorrhea is caused by another condition, it is secondary. This may occur anytime after your first period.

What causes dysmenorrhea?

During your period, certain hormones (body chemicals) are made to help your uterus contract (squeeze). Too much of these hormones may cause dysmenorrhea. More hormones will make your uterus contract more, causing primary dysmenorrhea. Secondary dysmenorrhea is caused by a pelvic problem or disease that increases the hormones. Any of the following may cause secondary dysmenorrhea:

• Growths: These include tumors, such as polyps or myomas in or on your uterus, and cysts in your ovary.
  
  
• Endometriosis: Tissues that line the inside of your uterus can grow in other body areas. They may grow on your ovaries, bowels, and other parts of your body. During your period, these tissues also thicken and shed. Pain is felt when blood and tissue are trapped in your pelvic area, or when scar tissue forms.
  
  
• Pelvic inflammatory disease: This is an infection of your female pelvic organs, such as your uterus, fallopian tubes, and ovaries.
  
  
• Use of intrauterine device: An intrauterine device (IUD) is a birth control method. It is a small, flexible T-shaped plastic that is put into your uterus to prevent pregnancy.

What puts me at risk of having dysmenorrhea, or of dysmenorrhea becoming worse?

The factors that increase your risk of having dysmenorrhea may also make period pain worse. Your risk may increase if you had your first period at 12 to 13 years of age. It may also increase if you are 20 years of age or younger, or have never given birth. Period bleeding that is heavy, or that lasts for at least six days also puts you at risk. The following may also increase your risk of having dysmenorrhea, or making it worse:

• Being under stress.
  
  
• Depression (deep sadness) or anxiety (worry).
  
  
• Drinking alcohol, such as beer, wine, vodka, and whiskey.
  
  
• Not having enough fish in your diet.
  
  
• Smoking, or being around tobacco smoke.
  
  
• Trying to lose weight.
  
  
• Weighing more than what your caregiver suggests.

What are the signs and symptoms of dysmenorrhea?

Symptoms of dysmenorrhea can be mild or severe (very bad). With primary dysmenorrhea, your symptoms may last for 2 to 3 days. With secondary dysmenorrhea, you may have heavy periods, bleeding between periods, or different numbers of days between periods. You may have any of the following signs and symptoms:

• Bloating (abdomen feels very full).
  
  
• Cramping with dull or sharp pain in your lower abdomen.
  
  
• Dizziness, light-headedness, or feeling faint.
  
  
• Feeling very tired, weak, or getting angry easily.
  
  
• Headache, backache, or leg aches.
  
  
• Loose or frequent stools.
  
  
• Nausea (upset stomach), vomiting (throwing up), or not feeling hungry.
  
  
• Pain or bleeding during or after having sex.

How is dysmenorrhea diagnosed?

Your caregiver will ask questions about your pain and other symptoms. Tell him when your pain starts and what you have used in the past to decrease your pain. Your caregiver will also ask about your periods and sexual activity. He needs to know if you have been pregnant, or if you are using birth control. He will also need to know if you have any medical problems, and if any other family members have dysmenorrhea. You may need any of the following:

• Pelvic exam: This is also called an internal or vaginal exam. During a pelvic exam, feel free to ask for a woman to be present if one is not. Your caregiver gently puts a warmed speculum into your vagina. A speculum is a tool that opens your vagina. This lets your caregiver see your cervix (bottom part of your uterus). With gloved hands, your caregiver will check the size and shape of your uterus and ovaries.
  
  
• Ultrasound and magnetic resonance imaging (MRI): These tests can show problems that may be causing your pain.
  
  
• Laparoscopy: A laparoscope is used to look inside your abdomen. The laparoscope is put in through a small incision (cut) in or below your belly button. Your caregiver uses the laparoscope to look for problems in and around your pelvic organs.

How is dysmenorrhea treated?

• Medicines:
  
  
  • Acetaminophen: This medicine is used to decrease your period pain. Taking too much acetaminophen can hurt your liver. Read labels so that you know what is in each medicine that you take. Talk to your caregiver before taking more than one medicine that contains acetaminophen. Ask your caregiver before taking over-the-counter medicine if you are also taking pain medicine prescribed (ordered) for you.
    
    
  • Hormones: These medicines help keep your normal hormone levels stable. They help control your periods by making them regular, or your menstrual cycle longer with fewer periods. They include birth control pills, needles, patches, and intrauterine devices (IUDs) that contain hormones.
    
    
  • Nonsteroidal anti-inflammatory (NSAID) medicine may decrease swelling and pain or fever. This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your primary healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow the directions on it before using this medicine.
  
  
• Surgery: Surgery may be done if your symptoms are bad, and other treatments have been tried and have not worked. Your caregiver may cut the nerve that goes to your uterus to ease your pain. Surgery to remove the uterus may be done if other treatments do not work.

What are the other ways to treat dysmenorrhea?

• Acupuncture: Acupuncture is a treatment based on a belief that fluids flow through channels in our bodies. Caregivers insert very thin needles just under your skin. This is believed to open the channels, allowing fluids to flow better. This treatment may decrease pain and improve healing. Always see a caregiver for acupuncture. Do not try to give this treatment to yourself.
  
  
• Diet changes and supplements: Eating vegetables, fruits, fish, and foods high in fiber may help decrease your pain. Choosing foods that are low in fat may also help. Supplements that may help decrease your pain include magnesium, and vitamins B and E. Omega-3 fatty acids (fish oil) and certain herbs may also help.
  
  
• Mind-body therapies: These include biofeedback, hypnotherapy, and relaxation. These therapies teach your body to respond in a different way to the stress of being in pain. When pain starts, your body reacts by making your muscles tense, heart beat faster, and blood pressure higher. Your breathing also gets faster and shallower. These reactions can make your pain worse. Mind-body therapies may help decrease your pain by changing these responses.
  
  
• Transcutaneous electric nerve stimulation: This is also called TENS. A special device is used to send mild signals from the nerves going to your brain. These signals may help decrease your pain when used over a painful body part.

What can I do to help my dysmenorrhea get better?

• Keep a pain diary. It may be easier to answer your caregiver's questions by making a pain diary or book. A pain diary will help you remember what happened each day because it is all written down. Write down when your periods start and stop. Write down all the words that come to you about your pain and other symptoms.
  
  
• Avoid drinks that contain alcohol.
  
  
• Apply heat on your lower abdomen. Applying heat on your lower abdomen using warm compresses or a heating pad may decrease pain. A warm moist compress is a small towel dampened with hot water and placed in a plastic bag. Wrap a towel around the plastic bag to prevent burns. Be careful if you use a heating pad by keeping it turned on low.
  
  
• Exercise: Stay active. Getting regular exercise often can decrease the pain. Exercise increases body chemicals that may help ease pain and make you feel better. Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you.
  
  
• Manage your stress. Stress may make dysmenorrhea worse. Find ways to help your mind and body relax, such as deep breathing. Stay away from people or things that make you feel upset. Talk to someone about things that upset you.
  
  
• Stop smoking and avoid people who smoke. Ask caregivers for information on how to stop smoking if you are having trouble quitting.

When should I call my caregiver?

Call your caregiver if:

• You have new symptoms, or they are worse than before.
  
  
• You feel very nervous or angry after you take your medicines.
  
  
• You have problems sleeping, thinking clearly, or feel so sad that you cannot cope.
  
  
• Your pain or other symptoms make it hard for you to do the things you enjoy.
  
  
• Your periods are early, late, or more painful than usual.
  
  
• You have questions about your pain, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You feel more pain even after taking your medicines.
  
  
• You have heavy vaginal bleeding and you faint or feel light-headed.
  
  
• You suddenly have chest pain and trouble breathing.

Where can I find more information?

• The American College of Obstetricians and Gynecologists
  P.O. Box 70620
  Washington , DC 20024-9998
  Phone: 1- 202 - 638-5577
  Phone: 1- 800 - 673-8444
  Web Address: http://www.acog.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Dysmenorrhea